Suena Massey, MD is a board-certified Psychiatrist with additional qualifications in Addiction Medicine who proposes the resubmission application for the Mentored Patient-Oriented Research Career Development Award (K23) entitled, Psychological Mechanisms in Prenatal Smoking Behavior Change. Based on her clinical work with pregnant and non-pregnant substance abusers, Dr. Massey aims to build a foundation for an independent program of research on the psychological characterization of women who successfully quit smoking during pregnancy as a basis for identifying modifiable factors linked to cessation that can be targets for future interventions. To accomplish this long term goal, in this K23 study, she will combine analysis of extant data in a large phenotypically characterized community sample with state-of-the-art longitudinal repeated prospective measurement of prenatal smoking patterns with a new pilot study. This strategy maximizes impact of the K-award study while providing necessary didactic training and mentored experience in the day-to-day conduct of independent research with a prenatal cohort. Specifically, she will examine differences in empathy between women who quit smoking during pregnancy and women who do not drawing on a prenatal cohort oversampled for prenatal smoking (R01 DA023653; PI: L. Wakschlag). Guided by these results, she will conduct a pilot study to develop a multi-level battery for assessing empathy in pregnancy and provide preliminary evidence for its utility for use in future large scale studies of prenatal smoking cessation. Complementing these scientific aims, training goals are to: (1) develop sophisticated analytic skills in multi-level modeling, random-effects regression, and creation of latent variables; (2) acquire depth of expertise in multi-level measurement of empathy including direct assessments, and (3) acquire training in intervention development. Dr. Massey's outstanding mentorship team includes Lead Mentor, Katherine Wisner, MD, MS, and Co-Mentor Lauren Wakschlag, PhD, and Advisors Daniel Mroczek, PhD (Statistician, Personality Research), Michael Fleming, MD (Intervention Development), Jordan Grafman, PhD (Cognitive Neuroscience), and William Grobman, MD (Obstetrics). If prenatal smoking cessation is independently related to empathic capacity as hypothesized, interventions aimed at increasing empathy during pregnancy can significantly improve smoking cessation rates and reduce prenatal exposures to nicotine. Enhancing the unique motivation for behavior change during pregnancy holds the potential to interrupt a devastating intergenerational transmission of risk, while yielding immediate health benefits for mothers.